Microsurgical efficacy and safety of a right-hemispheric approach for unruptured anterior communicating artery aneurysms

Abstract

OBJECTIVE: We investigated the effectiveness of a right hemispheric surgical approach in treating unruptured anterior communicating artery aneurysms.

METHODS: Between January 2005 and June 2012, 305 patients with anterior communicating artery (Acom) aneurysms were treated using the pterional approach. Among them, 113 who underwent microsurgery with an unruptured Acom aneurysm were enrolled in this study. Every patient was evaluated with digital subtraction angiography preoperatively and CT scans were taken several times postoperatively. Surgical outcomes and complications were evaluated at discharge using the Glasgow Outcome Scale and at 6 months after surgery with CT angiography.

RESULTS: Enrolled patients included 55 males and 58 females with a mean age of 56.3 years (range: 30-75 years). The mean diameter of the aneurysm was 5.8mm (range: 1.9-24.1). Left A1 dominancy was found in 71 patients (62.8%) whereas right A1 dominancy was found in 20 patients (17.7%), and right pterional craniotomies were performed in 92 patients (81.4%) while left pterional craniotomies were performed in 21 patients (18.6%). Complete clip application was achieved in 94.9% of patients (74 of 78) in right-side approach group but in only 81.3% of patients (13 of 16) in left-side approach group. Despite a left A1 dominancy and approached from the right, more than 90% of the patients had an excellent outcome at discharge (GOS 5) and more than 90% a complete aneurysm clipping at the 6-month follow-up CT angiography although it was not statistically significant.

CONCLUSION: Microsurgical clipping of the unruptured Acom aneurysm through a right-side surgical approach showed favorable postoperative clinical and anatomical outcomes, especially aneurysms smaller than 10mm.